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Claims Appeals Procedures

Important Notice: As of October 1, 2017, the MedStar Family Choice contract to provide Medicaid services to residents in the District of Columbia has ended. Learn more >

Claims Appeals

All claims appeals must be submitted in writing within 90 business days from the date of the explanation of benefits. Attach supporting documentation, such as clinical documentation, copies of the claim, EOB, and explanation for appeal (including why the provider believes the claim was denied incorrectly), and mail this information to the address listed on the form that you are submitting.

We will send an acknowledgement letter that we have received your appeal within 5 business days. You will receive a response regarding your appeal within 30 calendar days of receipt of all necessary information.

Second level appeals must be sent in writing to the address above within 30 calendar days from MFC's response letter. We will send an acknowledgement letter that we have received your appeal within 5 business days. You will receive a response letter regarding your appeal within 30 calendar days of receipt of the appeal.

If the claims denial is overturned, you will receive payment within 30 calendar days of the decision.

For a status on a claims appeal, please call our Claims Department at 800-261-3371.

Tips:

  • Do not send in late appeals as they will not be considered.
  • Providers with corrected claims should send these to our claims address for processing; appeals are for claims denied as originally submitted.
Information current as of: 10/09/17